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1. Molecular Markers Analysis. Press Release by YAHOO! Finance: Data Presented at the 33rd Annual Meeting of the American Association of Endocrine Surgeons American Thyroid Association Guidelines for Patients with Thyroid Nodules recommended to use molecular markers (e.g., BRAF, RAS, RET=PTC, Pax8-PPARg, or galectin-3) for patients with indeterminate cytology on FNA to help guide management. The presence of any of these markers within thyroid nodules has been strongly correlated with malignancy. These mutations and translocations are found in at least 70% of differentiated thyroid carcinomas. BRAF mutations have been shown to correlate with more aggressive forms of cancer. Mutation analyses of these markers have been shown to improve the preoperative identification and prognostic assessment of thyroid malignancies and enable an optimized surgical strategy (Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. THYROID, Volume 19, Number 11, 2009, RECOMMENDATION 8 a) We are now able to determine BRAF p.V600E, KRAS p.G12A, NRAS p.Q61R, KRAS p.G12C, NRAS p.Q61K, KRAS p.G12S, NRAS p.Q61L. KRAS p.G12R, HRAS p.G12V, KRAS p.G12V, HRAS p.Q61L, KRAS p.G13D, HRAS p.Q61R, KRAS p.G12D, RET/PTC1 TRANSLOCATION, RET/PTC3 TRANSLOCATION, PAX8/PPARγ TRANSLOCATION in a SINGLE needle biopsy performed from the thyroid nodule. Most of the insurances provide reimbursement for this test. Result is available within 2 weeks. 2. Thyroglobulin Washout Thyroglobulin is a protein that is produced by thyroid cells or thyroid cancer cells. Determination of thyroglobulin in the serum is important test to follow on thyroid cancer recurrence in patients who were treated with radioactive iodine after thyroidectomy. Patients are following postoperatively with screening neck ultrasound. Some patients may develop lymph nodes. We now have an ability to detect thyroglobulin in lymph nodes when we suspect cancer recurrence or metastasis. This test is called “thyroglobulin washout” and is being performed routinely on lynph nodes biopsy of the patients with enlarged lymph nodes and history of thyroid cancer. 3. Laparoscopic Posterior Retroperitoneal Adrenalectomy (through the back). It is more modern and advanced technique that was developed by Professor Walz form Germany. It has significant advantage of avoiding entrance into the abdominal cavity that results in significantly less postopretaive pain, quicker recovery, can be performed on any patients even those who have had multiple abdominal surgeries and developed sever adhesions. The cosmetic result is much better then abdominal approach. Almost each surgeon in United States and all over the world, who is able to perform this technique, had to visit Dr Walz's Hospital in Germany and learn technique of posterior adrenalectomy from him.
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